Promoting Healthy Eating and Active Living Foundations For Community Health Workers (2nd Edition) (2016) Berthold, T., Editor San Francisco, C.A.: Jossey-Bass Chapter Seventeen Copyright © 2000-2017 by John Wiley & Sons, Inc., or related companies. All rights reserved. Promoting Healthy Eating and Active Living

Reflection of Last Session What did you learn? Share data you found about local chronic disease Patient self-management Role of CHWs Have students review what they learned from the last session on these key topics.

What You Will Learn Identify key challenges to changing diets and levels of physical activity Explain the general guidelines for healthier eating and drinking Explain the general guidelines for healthy levels of regular activity or exercise Analyze why a focus on health rather than weight may be most effective in supporting a client’s well- being and in fostering positive relationships between CHWs and their clients Take time to discuss the objectives for today.

What You Will Learn Explain a five-step approach to providing health education about nutrition, physical activity, or other health topics Describe how to apply client-centered concepts and skills for supporting clients to establish healthier patterns of eating and living Take time to discuss the objectives for today.

Words to know Body Mass Index (BMI) Vegetarian Food Security Vegan Food Insecurity Weight-Cycling Saturated Fat Weight-Inclusive Trans Fats Weight-Normative

Healthy Eating and Active Living

Common Barriers to Changing Our Diets Family & Culture Pleasure Time & Money Lack of Confidence Prejudice, Stigma, Low Self-Esteem, and Depression

Health Promotion and Weight Traditional weight-normative approach identifies certain people as having normal weight and others as overweight or obese Views weight as a key indicator of health Health focus is on weight-loss and dieting Often results in pattern of weight-cycling, that is harmful to physical and mental health Weight-inclusive approach equally respects people of all body sizes and weight Focuses on specific health issues, behaviors, and outcomes Emphasizes client-centered practices Shown to improve physical and mental health outcomes

Principles of Weight-Inclusive Approach to Health Do no harm. Appreciate that bodies naturally come in a variety of shapes and sizes, and ensure optimal health and well- being is supported for everyone, regardless of weight Given that health is multidimensional, maintain a holistic focus Encourage a process focus (rather than end-goals) for day-to-day quality of life

Principles of Weight-Inclusive Approach to Health (cont.) Critically evaluate the evidence for weight loss treatment and incorporate sustainable, empirically supported practices in prevention and treatment efforts Create healthful, individualized practices and environments that are sustainable Where possible, work to increase health access, autonomy, and social justice for all individuals along the entire weight spectrum. Trust that people move toward greater health when given access to stigma- free health care and opportunities.

Key Arguments in Favor of the Weight-Inclusive Approach The Weigh-Normative Approach may: The Weight-Inclusive Approach can: Influence clients to invest time and energy without long-term success Set patients up for years of weight cycling Shift attention away from more achievable health outcomes Stigmatize and shame people Undermine or damage clients’ trust in the professional relationship Uphold CHW code of ethics Avoid further stigmatization Apply client-centered concepts to support autonomy and development of sustainable action plans Support patients of all sizes to focus on key health goals Support patients to significantly improve physical and mental health Develop and maintain professional relationships that enable trust and mutual respect

Talking About Weight and Health: Role Play, Counter

Talking About Weight and Health: Role Play, Counter What was the CHW’s approach to supporting this client? How did the CHW address the issue of the client’s obesity? How effective do you thin the CHW’s approach was for this client? What information did the client provide about her experience with dieting, weight loss, and health? What would be a more effective way to support this client to promote her health and well being?

Talking About Weight and Health: Role Play, Demo

Talking About Weight and Health: Role Play, Demo How did the CHW address the issue of weight and health in this role play? How effective was the CHW’s approach? How did the client respond? What did you like that the CHW said or did in the role play? What would you do differently in working with this client, and why?

Nutritional Guidelines Copyright © 2011, Harvard University. For more information about The Healthy Eating Plate, please see The Nutrition Source, Department of Nutrition, Harvard School of Public Health, www.thenutritionsource.org, and Harvard Health Publications, www.health.harvard.edu.

Practical Guidelines for Healthier Eating Support clients to develop nutritional plans that are: Affordable Accessible Realistic With the Family in Mind Enjoyable Non-judgmental

Approaches to Providing Health Education About Nutrition Determine what the client already knows Determine their interest in learning more Share general information Keep culture – and cultural humility – in mind Provide more detailed nutritional information Keep the information practical and specific to the client’s life circumstances

Supporting Clients with Healthier Eating Identify ways to make a meal healthier: Not eating or drinking a particular item (example, drinking soda) Eating less of a particular item (a smaller order of fries) Eating or drinking more of an item (such as more vegetables) Substituting one food or drink for another (water instead of soda) Support clients to develop a plan for preparing a healthy meal. The plan should include: Where the client will shop A shopping list A menu for the meal Recipes (should be easy to follow, and shouldn’t require too many steps or ingredients)

Supporting Clients with Healthier Eating Other options: Visit the client’s home to talk about the foods they have on hand, and how those foods may impact their health Join the client on a trip to the grocery store and talk about food choices Keep sample packaged foods on hand. Together with clients, examine labels and recommended portion sizes, to enhance understanding of key ingredients, such as trans fat Become an expert on local resources: Educational and support groups related to healthy nutrition Food pantries Hot meal programs Programs that teach people how to prepare healthy and culturally relevant meals

Hypertension and Healthy Eating Pt. 1: Role Play

Hypertension and Healthy Eating Pt. 2: Role Play

Hypertension and Healthy Eating Pt. 3: Role Play

Physical Activity Physical activity is defined as anything that gets the body moving (even if you’re doing the activity while sitting down) Health benefits: Reduces risk of developing many chronic conditions Helps manage chronic conditions Strengthens bones and muscles Improves mood and mental health Associated with longer life-expectancy

Physical Activity Guidelines (CDC) http://www.cdc.gov/physicalactivity/basics/adults/index.htm

Supporting Clients to Increase Activity Levels When helping clients to develop an action plan, keep the following concepts in mind: Injury prevention Gradual or Incremental Change Realistic and Affordable Accessible Enjoyable Non-judgmental With Others, or On Their Own Community Resources

The Value of Taking Small Steps: Interview

The Value of Taking Small Steps: Interview What health issues and barriers did David say his client faced? As a coach, what approach did David take to supporting this client to increase her level of physical activity? What value did engaging in physical activity have for this client? What did you learn that you may wish to apply to your work as a CHW?

Action Planning and Exercise: Role Play, Demo

Practice Let’s get healthy! For the next week try to remove/reduce one unhealthy item from your diet or increase your amount of physical activity. Complete Chapter 17 HW & DB in Blackboard Read Chapter 18

Resources: Image on slide 2 digital-drugs-binaural-beats by digitalbob8 is licensed under CC BY 2.0 Image on slide 3 Bring Light Bulb is available in the public domain under CC0 Public Domain Video on slide 5 Healthy Eating and Active Living: Making the Healthy Choice the Easy Choice (English) by American Cancer Society is licensed under a Standard YouTube License Video on slide 11 Talking about Weight and Health: Role Play, Counter by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 13 Talking about Weight and Health: Role Play, Demo by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 20 Hypertension and Healthy Eating, Part 1: Role Play, Demo, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 21 Hypertension and Healthy Eating, Part 2 Role Play, Demo, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License

Resources: Video on slide 22 Hypertension and Healthy Eating, Part 3 Role Play, Demo, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 24 Physical Activity Guidelines -- Introduction by Centers for Disease Control and Prevention is licensed under a Standard YouTube License Video on slide 26 The Value of Taking Small Steps: Interview, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Video on slide 28 Action Planning and Exercise: Role Play, Demo, Foundations by Foundations for Community Health Workers is licensed under a Standard YouTube License Image on slide 29 Bike is available in the public domain under CC0 Public Domain

Acknowledgements: MoSTEMWINs Adapted from the Foundations for Community Health Workers, 2nd Edition (Berthold) with permission from Wiley Publishing. Unless otherwise noted this material by St. Louis Community College is licensed under a Creative Commons Attribution 4.0 International License. This product is partially funded by the MoSTEMWINs $19.7 million grant from the U.S. Department of Labor Employment and Training Administration. The product was created by the grantee and does not necessarily reflect the official position of the U.S. Department of Labor. The Department of Labor makes no guarantees, warranties, or assurances of any kind, express or implied, with respect to such information, including any information on linked sites and including, but not limited to, accuracy of the information or its completeness, timeliness, usefulness, adequacy, continued availability, or ownership MoSTEMWINs